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July 19, 2011

IAS 2011: Comorbidities and non-AIDS events

Comorbidities and non-AIDS events

Santiago Moreno described a cross-sectional population of 1443 patients from 27 Spanish hospitals in October 2010.

Median time from HIV diagnosis was 12 years. Only 9% of the patients had never had antiretroviral therapy (ART), and median time on ART in those treated was 10 years. At the initiation of ART, median CD4 count was 235 cells/mm3, and median HIV RNA was 61,454 copies/mL.

The interesting part: A median of 2.3 comorbidities and/or non-AIDS events were present in 1,103 patients (76.4%). Most frequent events were cardiovascular risk factors (45%), HCV/HBV coinfection (25%), abnormal fat distribution (10%), major psychiatric disorders (4.6%), neoplasia (2.1%), bone abnormalities (1.9%), and cardiovascular diseases (1.8%). Less frequent disorders included kidney disease (1%), and neurocognitive dysfunction (0.5%).

A logistic regression analysis was performed to identify factors associated with the development of comorbidities or non-AIDS events: age>50 years, injection drug use as risk practice, and duration of ART were associated with the risk of developing one or more events.

Reporter comment: Cardiovascular risk factors (smoking, obesity, lipid disorders, hypertension) and hepatitis B/C coinfections were the major comorbidities here; not surprising. This study just tells us how we should be prioritizing our time and effort for our patients.

The multivariate analysis is equally telling: older patients who have been on antiretrovirals for 10 or so years should be the focus of our primary care interventions. Cardiovascular risk management would appear to be a major focus within that group.

Reference: Moreno S, Domingo P, Antela A, et al, from the HIV 2020 Study Group Spain. Comorbidities and non-AIDS events among HIV-infected patients in Spanish hospitals [Abstract]. Presented July 19, 2011 at the 6th IAS Conference on Pathogenesis, Treatment and Prevention, Rome, Italy. Poster Presentation TUPE134.

Source: Reporting for PRN News from Rome, Italy: Bill Valenti, MD